1. Infertility Management and Referral
Laura Neale

2. History and Examination
Unprotected sex 1 year (unless known problems)
Primary or secondary
Predisposing factors
Menstrual cycle
STIs
Previous ectopics
Galactorrhoea/hirsutism/acne
Systemic diseases
Drug history (NSAIDs, chemotherapy, neuroleptics)
Lifestyle factors
BMI
Features of PCOS

3. Investigations (1) Anovulatory Male factor Unexplained Tubal Other
Think in terms of cause
Anovulatory
Male factor
Unexplained
Tubal
Other

4. Investigations (2) Day 2-5 FSH and LH Day 21 progesterone
Semen analysis
Rubella screen
Chlamydia screen

5. Investigations (3) If anovulatory
TFTs
Prolactin
Oestradiol
Testosterone
SHBG
Assess tubal status (unless semen analysis abnormal)

6. Counselling Optimise weight Usual lifestyle advise Folic acid
Investigative course
Costs (emotional and financial)
Chances failure (i.e. only 15% success rate per IVF cycle if age > 36)